Is ‘COVID Tongue’ a new post-COVID-19 symptom?

Some of the most common symptoms of COVID-19 are fever or chills, cough, shortness of breath or difficulty in breathing, fatigue, muscle or body aches, headache, loss of taste or smell, sore throat, congestion or runny nose, nausea or vomiting, and diarrhoea.

Initial studies by researchers identified COVID-19 as a disease primarily affecting the respiratory system. But recent studies are increasingly demonstrating that it is a multi-system disorder, with some patients experiencing unusual symptoms such as skin lesions, swollen and eyelids. Some of these symptoms are captured in Factcheck-Ghana’s report on “Unusual signs of Covid-19 many people may not know”, published in August 2020.

However, a story sighted by Factcheck-Ghana on some online news portals indicates that  “some Covid-19 patients are developing a condition that causes their tongue to permanently expand so much that they cannot speak or eat.”

The publication said one Dr James Melville, one of the top researchers of the condition, is aware of symptom and treated about two out of nine of such cases recorded. The publication also added:

“One case was that of Anthony Jones, a Houston man who developed the condition after being hospitalized with the virus. Jones had to use a ventilator in order to handle the virus, and when he woke up after treatment, his tongue was so swollen that he could not speak or eat. Dr Melville had to perform surgery to reduce the massive size of Jones’s tongue and alleviate the inflammation. The operation was a success, but how Jones became inflicted with massive macroglossia [swollen tongue condition] is still unknown to doctors.”

Factcheck-Ghana has verified the report and concluded that the story is true but misleading. Even though several news websites including the Houstonchronicle.com, Newsweek.com, and khou.com have published that some of these patients have been hospitalised from COVID-19, it has not been established that the virus is directly responsible for the condition as explicitly put out in the caption of the story.

In this explainer, therefore, Factcheck-Ghana looks at what Macroglossia is, the causes, the symptoms, its diagnosis, treatment, whether or not it can be directly linked to COVID-19 as a post-symptom, and if Ghanaians should be alarmed with the development.

What is Macroglossia?

Macroglossia is a disorder in which the tongue is larger than normal. It is most often caused by an increase in the amount of tissue on the tongue, rather than by a growth, such as a tumour.

What are the causes of Macroglossia?

Macroglossia can be congenital– present from birth –or acquired– developed later in life. Congenital causes may include various syndromes like the following;

1. Down syndrome: A condition in which someone has an extra chromosome.
2. Beckwith-Wiedemann syndrome: A syndrome that causes abnormal growth in different parts of children’s bodies and tends to slow at about the age of 8. The disorder causes large body size, large organs, and other symptoms.

• Mucopolysaccharidosis: A condition in which the body cannot break down sugar molecules in the body.

1. Hemangioma: The abnormal growth of blood vessels which usually shows in the form of a birthmark that fades over time. Sometimes it can adversely affect the area of growth, in this case, the tongue.
2. Congenital hypothyroidism: Partial or complete loss of thyroid function. The thyroid gland creates hormones necessary for a variety of things, one of them being growth.
3. Neurofibromatosis: Causes tumours to grow in nerve tissue.

Some of the Acquired causes may include conditions or diseases like;

1. Hypothyroidism: With this condition, the thyroid gland doesn’t produce enough crucial hormones and can result in a large tongue.
2. Amyloidosis: When an abnormal protein called Amyloid builds up and disrupts the function of certain organs in the body, according to Stanford Healthcare, it can also affect the tongue.

• Acromegaly: The pituitary gland produces too much growth hormone and typically results in overgrowth of the hands, feet, and face.

1. Pemphigus Vulgaris: An autoimmune disease that can cause swelling and blistering on the tongue.
2. Diphtheria: A bacterial infection that can be spread through respiratory droplets from coughing or sneezing. It can be prevented with a vaccine.
3. Tuberculosis: A bacterial infection that mostly affects the lungs but can also cause lesions and the enlarging of the tongue.

• Sarcoidosis: An inflammatory disease that usually causes abnormal growths in the lungs, eyes, lymph nodes, and skin but can also affect the tongue.

Symptoms of Macroglossia

The main symptom associated with Macroglossia is when the tongue is proportionally too large for the mouth, resulting in one or more of the following: Misaligned teeth; Protruding teeth; Interference with eating; Interference with speaking; Snoring and High-pitched breathing.

Diagnosis of Macroglossia

Medical professionals diagnose macroglossia by performing a physical examination. Underlying cause of the enlarged tongue may be determined by performing appropriate medical testing. Also, due to the numerous potential causes of this condition, the tests can vary.

Treatment for Macroglossia

Treatment also varies depending on the cause and severity of the enlarged tongue. If the cause of one’s macroglossia is both identifiable and treatable, there are medical therapies available. For example, if the cause is determined to be hypothyroidism, treatment for that condition may also help treat the macroglossia. In cases where the cause isn’t clear, medical therapies haven’t been shown to be useful.

In mild cases of macroglossia, speech therapy may improve issues with speaking. In more severe cases, the healthcare professional may recommend surgery to reduce the size of the tongue. Surgical procedures can help reduce problems with speech, chewing, and feeding.

Are the reported cases directly caused by COVID-19?

Medics have not been able to establish causality between Macroglossia and COVID-19 yet. Doctors in Houston are trying to figure out why a handful of people hospitalised with COVID-19 develop massively enlarged tongues.

Dr James Melville, from the University of Texas Health Science Center at Houston School of Dentistry (UTHealth), who has become a specialist in dealing with the condition has performed surgeries to help patients regain use of their tongues.

When KHOU 11 first reported on the condition in November 2020, Dr. Melville said there were only two documented cases in the United States. Since then, he has heard about seven more patients. Out of the nine cases, all had been intubated in a hospital. Eight out of the nine are Black. Two had suffered strokes and the other seven were hospitalised with COVID-19 prior to developing macroglossia.

Melville says the patients who had survived COVID-19 had inflammatory cells in their tongue tissue, which means there’s something about the virus that is making certain people more prone to the rare condition.

“I think it has a lot to do with where the virus is attaching itself and the body’s immune response to it,” said Dr Melville.
He said he is now undertaking a study to establish if there’s a common link in those patients’ genes. If doctors can answer that question, they hope they can also establish how to prevent the condition.

Should Ghanaians who have recovered from COVID-19 harbour any fear?

Even though seven out of the nine patients Dr Melville has taken care of had been hospitalised for COVID-19, he says he is yet to establish a conclusive correlation between the conditions.

According to Newsweek.com, the doctor said he was now trying to find out whether the COVID-19 patients with macroglossia shared certain genetic characteristics that could shine a light on the condition—and potentially how to prevent it.

Meanwhile, a Medical Doctor, Justice Duffu Yankson, who is also General Secretary of the Ghana Medical Association said Ghanaians need not panic.

He says notwithstanding the outcome of the research that’s still underway; several factors might have accounted for those cases which necessarily might not be related to the virus itself.

“Tongue getting bigger can come out from so many things. You know people are allergic to things and when they take in or come into contact with such things, it results in a whole lot of issues. So probably, the medication that was given to the person [to treat the COVID-19] could have caused that because the person may be allergic to it. So, let’s wait and see what the research brings,” he said.